help with breastfeeding

[cem86]

I am a new mum. My child is 3 weeks old today, he was born at 36wks. I am solely breastfeeding. He is slowly gaining weight, however I was upset when he was weighed last as in 7days he gained,5oz, now 7lbs however he had gone from the 9th centile to the 2nd. The hv didn't think my milk was a problem,possibly his latch and that he can be sleepy, therefore nor getting the hindmilk. However my concern is he feeds 3hourly at least, most days does a cluster, however its at different times each day. I often feel I am always feeding or I don't know where one feed ends and the next begins! Hes on one for around 25-30 mins and then the other for maybe5-10mins. He has lots or wet and dirty nappies. He seems well to me.. usually wakes for his feeds, some days hes more sleepy than others. I am just worried I am doing something wrong and that's why hes not gained enough weight. I dunno if he gets the hindmilk, its hard to know. Can anyone offer advice/ reassurance? Thanks

My best advice to you is:

--When he gets sleepy and you know he still needs feeding, tickle his feed or stroke the palms of his hands. This should wake him up and he should begin to resume sucking.

--If you can try and remember what breast he ended on last. So if he takes the left first then the right, start on the right the next time, as that will have the most amount of hindmilk left as he was unlikely to take as much from the previous feeding.

--Is he doing regular wet nappies (6 or more times a day)? Some babies lose weight quite a bit, where others gain quite a bit so it depends. Is your HV worried about him dropping centiles? If you are worried about the latch you could go to a BFing counsellor or a support group.

It might even be worth trying different positions. Do you feel sore at all when you are feeding? A proper latch should feel like a light tug that to me felt quite tickly and certainly not painful.

At the start my daughter had a bit of a poor latch and I was inexperienced so that didn't help either. Now she is great and we work together and she is 5 months old. I still supplement because it is what she is used to but she spends from 11 at night til about 12 midday just feeding on breast milk. It was around the 3 month mark I noticed such an improvement.

I am sure someone else will come along and mention tongue tie too - has that been checked for? This can make latching on a lot more difficult for a baby and can be cut if necessary.

If you are worried about the latch don't hesitate to ask your HV they should have details of local groups or breastfeeding helpers that may be able to give you some more one to one help and not just a quick fleeting visit.

I am sorry I can't be any more help. Congratulations on having a lovely baby by the way

I would echo all that advice, and just say that if latch feels comfortable and baby is doing lots of wet nappies, you shouldn't worry. It takes a while for them to fall into any kind of a routine, and the first few weeks can feel like you're feeding all the time.

He was obviously small to start with as a bit early, so that's just where he is for now the centilws are only a guide - I'm sure you're doing a wonderful job.

Congratulations.

Sorry about the typos.

Echo all that advice.

If you're thinking he's not getting hindmilk, hw about expressing off quickly before a feed getting rid of the foremilk?

Some babies gain weight slower than others. So long as he's having wet and dirty nappies carry on doing as you're doing.

Maybe try a sling too.

cem, your description of your baby's weight and feeding pattern all sounds normal....trying to keep babies awake by tickling and blowing and so on is only really necessary when there is a serious concern about weight and intake, and otherwise, it's kinder to let the baby sleep :)

Weekly weighings are not good practice, because they don't give an accurate indication of growth, and once a baby is back to birthweight it is clinically unnecessary in most cases to weigh more than once a month - your red book will confirm this.

There's no evidence in your post that your baby is not gaining as he should, but if you feel he needs more milk then the keeping-him-awake-thing is not really a good idea. Instead offer more 'sides' and/or offer breast compression (google it). But the chances are overwhelming that you don't need to do anything and that all is well :)

Flatasawitches - no....that is so not a good idea :( :( :(

Sorry, the sling idea is ok, but not the expressing and discarding the foremilk.

2 things occur to me.
One is that if he was born at 36 weeks, that is quite early and therefore may be sleepier than other newborns, hence the necessity to keep him awake for feeds (this happened with my DS1)
Secondly, earlier babies are more likely to be jaundiced, which makes them sleepier, and apparently makes it more important that they feed regularly ( so I was told by HV). The same HV missed that he was jaundiced for some time, so her advice may or may not be good. It is easy to miss signs of jaundice in a summer baby - mine just had a slightly more olive-y skin tone than one might expect. i would recommend getting this checked.
Thirdly, most babies lose weight after birth, and breastfed babies are slower to put it back on.

And last ( thats 4 things, not 2, I found that breast fed babies tend to feed quite irregularly, and varied tremendously in feeding times. They also get greedy days( to do with growth) when they seem to feed all day. This is normal, and stimulates milk production. I found it was every 4 or 5 days, I'd need a sofa day and not really expect to do anything other than feed. With DS1 this was often 40/50 minutes at time, 9 or 10 times a day, more than I thought possible.

It settles down after a few months.
Make sure you are eating and drinking enough yourself. Don't worry too much about which side, hindmilk/foremilk etc, although for your own sake you'll want fairly balanced bosoms - no good for self-image if one is huge and the other not!

Why is that Tik? The expressed milk can be kept in the freezer. Can you tell me why?

flataswitchestit , baby is 3 weeks so probably to early to start expressing?

Flat, think about what you are asking a mother to do, and the physiology of it all.

It is simply not the case that the first milk taken off the breasts is always 'foremilk'. thefunnyshapedwoman.blogspot.co.uk/2011/05/foremilk-and-hindmilk-in-quest-of.html is one of a nunber of sources on the web which explains this.

In addition. the task of expressing (not always easy) and storing is a hassle.

On top of that, it's not necessary. There's not a jot of evidence in the OP's post that the baby is 'not getting the hindmilk'.

If there is a concern over a baby's weight and intake, more frequent and effective access to the breast is the most effective response, with 'engineering' restricted to maybe breast compression to get the baby to take more if he loses interest....which would enable (easily) creamier milk to get into the baby. But really, it's volume of milk that is important for weight gain. Messing about with expressing and removing 'foremilk' is a nuisance and would only ever be justified in cases of weak, perhaps pre-term and underweight babies who cannot take/don't have the energy to take normal volumes.

Hope that explains it :)

Tik whilst I agree with some of what you're saying, I'm personally a believer in the sense of there is a fore milk and hind milk however our local bf specialist doesn't and thinks there's milk and that's it!

With my last baby I had the same problems as OP and felt a lot of pressure to give top ups and declined being readmitted a few times as baby wasn't gaining weight as quickly as they wanted luckily I stood my ground and did what you suggested with breast compression, and literally had a boob out coaxing baby at all times. I did also express but only because I was already expressing as babe started off in scbu (35 weeks) and it was suggested to me to express off foremilk by some colleagues (am a midwife)

Ironically weeks later she was diagnosed with posterior tt and had awful reflux and colicky type symptoms - again the recommendations on kellymom etc were to express off in case of a fore/hind milk imbalance!

I was only suggesting OP, feel free to ignore my advice.

Thanks for all the advice. And reassurance that others have been there. I will give the compression a go and see. Also going to head to my local breastfeeding support group next week. Thanks again.

flat I'd echo what Tiktok said. Dd was a 27 weeker and developed awful reflux with cmpi and tongue and lip ties (which I now know is due to our family's love of the MTHFR gene). She choked and spluttered so much at the start of feeds so I used to express off the 'rush' til I realised I was programming my boobs to keep producing an excess of foremilk. Block feeding is a much better way of curtailing it. If you express it off your body mistakenly believes its being needed and taken by dc.

Flat, glad things worked out for you:)

But personal 'belief' in the physiology of lactation is misplaced - this is something we know about from empirical investigations, and whether you 'believe' in something does not change how bf works.

Milk in full breasts is proportionately higher in water than milk in 'emptier' breasts - erroneously, this has been termed 'foremilk' and 'hindmilk' with some resulting confusion. It's notable you are a midwife and the suggestion to express off the foremilk came from your colleagues - I see massive confusion among HCPs including midwives about this, and it's disconcerting that you still persist in a 'personal belief' about fore/hindmilk in the face of the robust scientific evidence of what really happens.

Your situation is different from the OP's - as far as we know, there is no offer of hospitalisation for the OP's baby. There are, as I said, some situations where 'lactengineering' might be appropriate. The OP's situation is not one of them, and would just (IMO) lead to extra hassle and inconvenience.

Yep I forgot to add block feeding too.

:( :(

Block feeding is absolutely not the right response in a situation where there is even a possible concern over the baby's intake.

Block feeding reduces volume of milk made.That's ok in cases of problematic over-supply, but not otherwise.

In the vast majority of cases (where there is no underlying worry like tongue tie, or anything else that might make a difference) as long as the baby is permitted free access to the breast and both he and the mum are comfortable, and milk is being transferred effectively, no one needs to do anything but follow the baby's lead :)

Ok well ignore all of my advice. Myself and experienced colleagues have obviously been trained completely wrong.

It's certainly possible that is the case, flat....sorry.

I prob sounded a bit passive-aggressive, flat, but the fact is that midwifery training in breastfeeding is known to have gaps and misinformation - there is a bunch of studies on it, and I can send you links.

If you think that block feeding is a possible 'fix' when a baby's intake/weight is possibly causing concern (as in the OP's situation), if you think 'getting rid of 'the foremilk' in order to allow a baby to 'get the hindmilk' is another possible 'fix' for this situation, then I suggest that you and your colleagues do have some training and information issues.

Many HCPs, including midwives, do have these misunderstandings, so you are not alone.

Just to let you know. Last weight was 7lbs 5oz
Feeding much better around 3-4 hourly. With the occasional cluster or wee Extra feed if hes unsettled. Feeling much happier about things. Just trying to relax and enjoy the closeness bf brings. Thanks. X

Sounds good, cem :)